The present invention relates to the design and composition of a depot implant for optimal delivery of growth factors to treat osteoporotic bone, in that such depot implant is constructed to be in a cylinder (rod) or sphere shape and have a natural or synthetic polymer scaffold with or without impregnated calcium phosphate particles. The density of the depot is higher than a typical BMP sponge carrier to facilitate it's implantation and slower release of the growth factor. The scaffold is such that it has adequate porosity and pore size to facilitate growth factor seeding and diffusion throughout the whole of the bone structure resulting in increased bone mineral density in the osteoporotic bone. In addition, the shape of the depot implant allows for delivery through a cannula or large bore needle.
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1. A depot implant comprising:
a physical structure which is shaped and allows for implantation and retention into a host bone; and a dense polymer scaffold making up the construct of the physical structure, the dense polymer scaffold impregnated with calcium phosphate particles comprising hydroxyapatite (ha) and tricalcium phosphate (TCP) in a ratio of 15 ha: 85 TCP to 35 ha: 65 TCP and comprising collagen and no polysaccharide, and a growth factor loaded in the dense polymer scaffold for delivery to the host bone and the dense polymer scaffold is disposed throughout the entire implant, and has a central hollow chamber disposed throughout the implant to facilitate seeding and diffusion of the growth factor and the implant has a porosity of 2% to 40%.
2. The depot implant according to
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8. The depot implant according to
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The present invention relates to the design and composition of an implant that is used as a growth factor depot to treat osteoporotic bone. More particularly, the depot is in the shape of a small cylinder (straight or curved) or sphere that can be delivered into osteoporotic bone through a cannula or large bore needle.
Osteoporosis is a major public health threat for an estimated 44 million Americans, or 55 percent of the people 50 years of age and older. In the United States, 10 million individuals are estimated to already have the disease and almost 34 million more are estimated to have low bone mass, placing them at increased risk for osteoporosis. Osteoporosis is often called a “silent disease” because bone loss occurs without symptoms. Indeed, people may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump or fall causes a fracture or a vertebra to collapse.
Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures, especially of the hip, spine and wrist, although any bone can be affected. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks. These broken bones, also known as fractures, occur typically in the hip, spine, and wrist. It is estimated that Osteoporosis is responsible for more than 1.5 million fractures annually, including:over 300,000 hip fractures; and approximately 700,000 vertebral fractures; 250,000 wrist fractures; and 300,000 fractures at other sites.
While osteoporosis is often thought of as an older person's disease, it can strike at any age. One in two women and one in four men over age 50 will have an osteoporosis-related fracture in her/his remaining lifetime. Any bone can be affected, but of special concern are fractures of the hip and spine. A hip fracture almost always requires hospitalization and major surgery. It can impair a person's ability to walk unassisted and may cause prolonged or permanent disability or even death. Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain, and deformity.
Depending upon the condition of the patient, new bone ingrowth is accomplished by one or more mechanisms such as osteogenesis, osteoconduction and osteoinduction. It can be appreciated that the needs of a child are different from an aging patient afflicted with osteoporosis. Accordingly, there is no “one size fits all” approach towards optimizing the healing conditions in a patient.
Current treatments of osteoporotic disease, such as a vertebral body known as a vertebroplasty, utilize cements that set-up in vivo after injection, however, these treatments have attendant risks. These cements have the potential to extrude into the spinal canal causing neural compression or to be forced into the venous blood network leading to emboli.
In addition, the following medications are approved by the FDA for postmenopausal women to prevent and/or treat osteoporosis:
Bisphosphonates:
Estrogen/Hormone Therapy:
Selective Estrogen Receptor Modulators (SERMs):
Treatments under investigation include sodium fluoride, vitamin D metabolites, and other bisphosphonates and selective estrogen receptor modulators. These therapies, however, only result in approximately a 0-3% increase in bone mineral density (BMD) per year. On the other hand, local delivery of a growth factor via depot implant results in a 10-50% BMD increase within a few months.
Despite the advances recently made in the art, there is an immediate need for improved medical devices, methods and systems for treating osteporotic bone.
The present invention fills the foregoing need by providing a growth factor depot implant and system for facilitating implantation of the depot into a host bone comprising implanting an implant depot loaded with a growth factor. Local delivery of a growth factor will result in 10-50% increase in bone mineral density within a few months.
In accordance with a first aspect of the present invention, a growth factor depot implant design provides a physical feature to facilitate implantation and retention of the implant in the desired anatomical location for optimal clinical efficiency in treating osteoporotic disease.
In an embodiment of the invention, the depot implant is in the shape of a small cylinder (straight or curved rod) or sphere that can be delivered into osteoporotic bone through a cannula or large bore needle. In a preferred embodiment, the depot would be about 1 to about 5 mm in diameter and about 5 to about 20 mm in length.
In another embodiment of the invention, provision is made for the depot implant to have a composition comprising a dense collagen scaffold impregnated with calcium phosphate particles. In yet another embodiment of the invention, the scaffold is designed with a central hollow cavity that can be filled with a growth factor. In a preferred embodiment such growth factor is then slowly released through the porous depot walls.
Another aspect of the invention provides for application of the growth factor to the depot during fabrication of the depot. A preferred embodiment of the invention, provides for a method of applying the growth factor to the depot at the time of surgery comprising dripping on or soaking in a solution of growth factor and, optionally further, can be placed into the internal structure of the dense depot by placing the depot into a vacuum chamber intra-operatively. Yet further, the growth factor can be injected into the depot.
Advantages of the design and composition of the implant depot are such that a slow release of the growth factor can be maintained thus avoiding transient bone resorption near the implant due to the high dose of growth factor in the depot. Another advantage to the design and composition of the implant depot is the prevention of entrance of the growth factor into venous system.
These and other objects and advantages of the present invention will be apparent from the descriptions herein.
To aid in the understanding of the invention, the following non-limiting definitions are provided:
The term “osteoconduction” refers to the ability to stimulate the attachment, migration, and distribution of vascular and osteogenic cells within the graft material. The physical characteristics that affect the graft's osteoconductive activity include porosity, pore size, and three-dimensional architecture. In addition, direct biochemical interactions between matrix proteins and cell surface receptors play a major role in the host's response to the graft material.
The term “osteogenic” refers to the ability of a graft material to produce bone independently. To have direct osteogenic activity, the graft must contain cellular components that directly induce bone formation. For example, a collagen matrix seeded with activated MSCs would have the potential to induce bone formation directly, without recruitment and activation of host MSC populations. Because many osteoconductive scaffolds also have the ability to bind and deliver bioactive molecules, their osteoinductive potential will be greatly enhanced.
The term “osteoinduction” refers to the ability to stimulate the proliferation and differentiation of pluripotent mesenchymal stem cells (MSCs). In endochondral bone formation, stem cells differentiate into chondroblasts and chondrocytes, laying down a cartilaginous ECM, which subsequently calcifies and is remodeled into lamellar bone. In intramembranous bone formation, the stem cells differentiate directly into osteoblasts, which form bone through direct mechanisms. Osteoinduction can be stimulated by osteogenic growth factors, although some ECM proteins can also drive progenitor cells toward the osteogenic phenotype.
The term “patient” refers to a biological system to which a treatment can be administered. A biological system can include, for example, an individual cell, a set of cells (e.g., a cell culture), an organ, or a tissue. Additionally, the term “patient” can refer to animals, including, without limitation, humans.
The term “treating” or “treatment” of a disease refers to executing a protocol, which may include administering one or more drugs to a patient (human or otherwise), in an effort to alleviate signs or symptoms of the disease. Alleviation can occur prior to signs or symptoms of the disease appearing, as well as after their appearance. Thus, “treating” or “treatment” includes “preventing” or “prevention” of disease. In addition, “treating” or “treatment” does not require complete alleviation of signs or symptoms, does not require a cure, and specifically includes protocols which have only a marginal effect on the patient.
For the purposes of promoting an understanding of the principles of the invention, reference will now be made to preferred embodiments and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the invention is thereby intended, and that alterations and further modifications of the invention and such further applications of the principles of the invention as herein being contemplated would normally occur to one skilled in the art to which the invention relates.
Referring now to the figures,
In the practice of the invention the growth factors include but are not limited to bone morphogenic proteins, for example, BMP-2, rhBMP-2, BMP-4, rhBMP-4, BMP-6, rhBMP-6, BMP-7 [OP-1], rhBMP-7, GDF-5, and rhGDF-5, as disclosed, for example, in the U.S. Pat. Nos. 4,877,864; 5,013,649; 5,661,007; 5,688,678; 6,177,406; 6,432,919; 6,534,268; and 6,858,431, and in Wozney, J. M., et al. (1988) Science, 242(4885):1528-1534. Bone morphogenic proteins have been shown to be excellent at growing bone and there are several products being tested. Extensive animal testing has already been undertaken, and human trials are finished and in process for these products. rhBMP-2 delivered on an absorbable collagen sponge (INFUSE® Bone Graft, Medtronic Sofamor Danek, Memphis, Tenn.) has been used inside titanium fusion cages and resulted in fusion in 11 out of 11 patients in a pilot study and 99% of over 250 patients in a pivotal study. In July, 2002 INFUSE® Bone Graft received FDA approval for use in certain types of spine fusion. A pilot study with BMP-2 delivered on a ceramic carrier was recently published and reported a 100% successful posterolateral fusion rate. BMP-7 (OP-1) has reported 50-70% successful posterolateral lumbar fusion results in human studies to date. On May 4, 2004, INFUSE® Bone Graft was approved for acute, open fractures of the tibial shaft (Bosse et al. NEJM 347(24): 1924-1931, 2002; Govender et al. JBJS 84(12): 2123-2134, 2002). Studies with these and other BMP's are underway. However, it is important to note that use of BMP's may add cost to an already very expensive operation.
Additionally, suitable growth factors include, without limitation, LIM mineralization protein, platelet derived growth factor (PDGF), transforming growth factor β (TGF-β), insulin-related growth factor-I (IGF-I), insulin-related growth factor-II (IGF-II), fibroblast growth factor (FGF), and beta-2-microglobulin (BDGF II), as disclosed in the U.S. Pat. No. 6,630,153, and PTH, PGE2-aganonist, and statins.
Referring now to
Referring now to
As such, the depot implant can be strategically inserted into osteoporotic bone areas in a minimally invasive procedure by entering the body through the skin or through a body cavity or anatomical opening, thus allowing for the smallest damage possible to these structures and correspondingly resulting in less operative trauma for the patient. Preferably, the depot implant is placed in an area of least bone marrow density for maximum impact of the growth factor.
The growth factor depot may be constructed from a number of materials consisting of natural and synthetic polymers, in solid or gel form, or a combination of each. Examples of plastic materials that the rods could be fabricated from are polyorthoesters (POE), Polylacticglycolic acid (PLGA) Polysacharides (Saber technology), Polycapralactone, Polyfumarate, Tyrosine polycarbonate, etc. Examples of materials that the gel could be fabricated from are Polyethylene glycol (PEG), Polysacharides (Saber technology), Polyorthoesters, Hyaluronic acid, Chitosan, Alginate, Albumin, etc.
Referring now to
Application of the growth (osteoinductive) factor to the depot may occur at the time of surgery or in any other suitable manner. For example, such application may comprise of dripping or soaking the depot implant in a solution of growth factor. Alternatively (or additionally), the growth factor may be further placed into the internal structure of the depot by placing the depot into a vacuum chamber intra-operatively. Further alternatively (or additionally), the growth factor may be further placed into the internal structure of the depot via insertion of a needle into the center of the depot. It is to be understood, of course, that the internal construction of the depot implant, either solid or hollow, would be independent of the method by which the growth factor may be introduced to the depot implant but may play a role in selection of such method. In many cases, the growth factor may be applied to either the calcium phosphate material or the binding matrix (i.e., collagen) prior to combining the materials and forming into the final depot shape. Indeed, the growth factor can be blended into the natural or synthetic polymer (i.e., POE) and poured into molds of the final shape of the depot implant. Alternatively, the factor, such as a bone morphogenetic protein in a suitable liquid carrier, may be applied onto and/or into the porous load depot body after forming into the final shape by soaking, dripping, etc.
It should be noted, of course, that the BMP load in the depot acts as an osteoinductive factor. Indeed, the preferred osteoinductive factors are the recombinant human bone morphogenetic proteins (rhBMPs) because they are available in unlimited supply and do not transmit infectious diseases. Most preferably, the bone morphogenetic protein is a rhBMP-2, rhBMP-4, rhBMP-7, or heterodimers thereof.
Recombinant BMP-2 can be used at a concentration of about 0.4 mg/ml to about 10.0 mg/ml, preferably near 1.5 mg/ml. However, any bone morphogenetic protein is contemplated including bone morphogenetic proteins designated as BMP-1 through BMP-18. BMPs are available from Wyeth, Cambridge, Mass. and the BMPs and genes encoding them may also be prepared by one skilled in the art as described in U.S. Pat. No. 5,187,076 to Wozney et al.; U.S. Pat. No. 5,366,875 to Wozney et al.; U.S. Pat. No. 4,877,864 to Wang et al.; U.S. Pat. No. 5,108,922 to Wang et al.; U.S. Pat. No. 5,116,738 to Wang et al.; U.S. Pat. No. 5,013,649 to Wang et al.; U.S. Pat. No. 5,106,748 to Wozney et al.; and PCT Patent Nos. WO93/00432 to Wozney et al.; WO94/26893 to Celeste et al.; and WO94/26892 to Celeste et al. All osteoinductive factors are contemplated whether obtained as above or isolated from bone. Methods for isolating bone morphogenetic protein from bone are described, for example, in U.S. Pat. No. 4,294,753 to Urist and Urist et al., 81 PNAS 371, 1984.
Referring now to
The dense collagen scaffold is impregnated with calcium phosphate particles. As calcium phosphate is a minerals containing calcium ions (Ca2+) together with orthophosphates (PO43−), metaphosphates or pyrophosphates (P2O74−) and occasionally hydrogen or hydroxide ions, it is easily absorbed by the body as a raw material for new bone cell growth. In a preferred embodiment of the invention, the calcium phosphate is either hydroxyapaptite or tri-calcium phosphate, or a biphasic blend of the two, ideally in a ratio of 15HA/85TCP to 35HA/65TCP.
Accordingly, in this aspect of the invention the density of the depot is much higher than a typical BMP sponge carrier so that the release of the BMP is much slower. As such, the longer release kinetic properties of this depot avoids the potential for local transient bone resorption, and instead a more rapid increase in bone deposition, which therefore ultimately achieves a higher bone mineral density with osteoporotic bone. In addition, the calcium phosphate component of the depot will also facilitate the prevention of local bone resorption by providing slower release of the BMP due to its increased binding potential and also act as a local source of calcium and phosphate to the cells attempting to deposit new bone.
In some embodiments, the osteogenic compositions used in this invention further comprise a therapeutically effective amount to stimulate or induce bone growth of a substantially pure bone inductive or growth factor or protein in a pharmaceutically acceptable carrier. The choice of carrier material for the osteogenic composition is based on biocompatibility, biodegradability, mechanical properties and interface properties as well as the structure of the load bearing member. The particular application of the compositions of the invention will define the appropriate formulation. Potential carriers include calcium phosphates, collagen, hyaluronic acid, polyorthoesters, polylactic acids, poly glycoloic acids, PLGA copolymers, polyanhydrides, polymeric acrylic esters, calcium sulphates and demineralized bone. The carrier may be any suitable carrier capable of delivering the proteins, nucleotide sequences, or the like. Most preferably, the carrier is capable of being eventually resorbed into the body. One preferred carrier is an absorbable collagen sponge marketed by Integra LifeSciences Corporation under the trade name Helistat® Absorbable Collagen Hemostatic Agent. Another preferred carrier is a biphasic calcium phosphate ceramic. Ceramic blocks and granules are commercially available from Sofamor Danek Group, Deggendorf, Germany.
All publications cited in the specification, both patent publications and non-patent publications, are indicative of the level of skill of those skilled in the art to which this invention pertains. All these publications are herein fully incorporated by reference to the same extent as if each individual publication were specifically and individually indicated as being incorporated by reference.
Although the invention herein has been described with reference to particular embodiments, it is to be understood that these embodiments are merely illustrative of the principles and applications of the present invention. It is therefore to be understood that numerous modifications may be made to the illustrative embodiments and that other arrangements may be devised without departing from the spirit and scope of the present invention as defined by the following claims.
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